An article of The Ultrasonic Imaging Laboratory in the Joint University of North Carolina at Chapel Hill, N.C. State University Department of Biomedical Engineering, which may be found at www.bme.ncsu.edu/labs/ULSlab/index.html, explains Acoustic radiation force impulse (ARFI) imaging. The article is incorporated herein by reference. The article states that “in ARFI imaging, an impulse of relative high acoustic energy is transmitted into the body to deliver spatially and temporally localized radiation force at the imaging focus in a manner that subtly pushes tissue away from the imaging transducer (tissue displacement is on the order of microns). Each ARFI impulse is followed by ensembles of conventional ultrasonic transmit-receive lines, which serve to generate data for ARFI-induced axial motion tracking with one-dimensional cross-correlation. Displacements measured in space and time may then be rendered into graphical and parametric image representations that depict differences in tissue mechanical properties.”
Some of the references cited below give more detail of ARFIs.
In an article entitled “Acoustic radiation force impulse imaging of myocardial radio-frequency ablation: initial in vivo results” by Fahey et al., published in IEEE Transactions on Ultrasonics, Ferroelectrics and Frequency Control, Volume 52, Issue 4, April 2005 Page(s): 631-641, the authors state that “Acoustic radiation force impulse (ARFI) imaging techniques were used to monitor radio-frequency (RF) ablation of ovine cardiac tissue in vivo.” The article is incorporated herein by reference.
In an article entitled “ARFI imaging of thermal lesions in ex vivo and in vivo soft tissues” by Fahey at al., published in the IEEE Symposium on Ultrasonics, 2003 Volume 1, pages 562-567, which is incorporated herein by reference, the authors state that “the ability of ARFI imaging to monitor the ablation of soft tissues both ex vivo and in vivo was investigated.”
U.S. Patent Application 20040147920 to Keidar, which is incorporated herein by reference, describes how ultrasound measurement may be used in assessment of ablation.
U.S. Pat. No. 6,658,279 to Swanson et al., which is incorporated herein by reference, describes a catheter for ablating and imaging tissue. The catheter includes a porous electrode.
U.S. Pat. No. 6,371,912 to Nightingale et al., which is incorporated herein by reference, describes a method and apparatus for the identification and characterization of regions of altered stiffness.summary of the invention
In an embodiment of the present invention, a probe positioned at the distal end of a catheter is used to perform ablation of tissue. The probe is also able to monitor the ablation. To perform the two functions, the probe comprises an ablation element and an ultrasonic transducer, mounted in proximity to each other. To monitor the ablation, the ultrasonic transducer is configured to transmit acoustic radiation force impulses (ARFIs) via, or in proximity to, the element to the ablated tissue. The impulses displace the tissue by an amount that depends on the elasticity of the tissue, and the transducer is also able to measure the displacement of the tissue. Since ablated and non-ablated tissues have different elasticities, the different displacements enable the ablation of the tissue to be monitored. By incorporating the ablation element and the transducer into the one probe, there is no need for a second ultrasonic device separate from the probe. Furthermore, since the ultrasonic transducer is close to the site of ablation, the ablation may be monitored more accurately and lower ultrasonic energies may be used, while still achieving comparable results to those of external transducers.
In some embodiments the ablation element comprises a radio-frequency (RF) electrode which is typically a sonolucent electrode. The transducer is mounted in acoustic contact with the electrode and the mounting is such that forward ultrasound waves generated by the transducer, as well as returning ultrasonic waves, traverse the electrode without appreciable reflection. The ultrasound waves that traverse the electrode comprise ARFIs, ultrasonic tracking pulses, and tracking pulse reflections used to monitor the displacement of the tissue due to the ARFIs. Alternatively or additionally, the electrode comprises an acoustically transparent aperture. The transducer is mounted so that the ultrasound waves described above travel through the electrode via the aperture.
In alternative disclosed embodiments the ablation element ablates cryogenically, or uses microwaves to perform the ablation.
In a further alternative embodiment, rather than the tissue ablation being performed using a separate ablation element, the tissue is ablated by ultrasound. In this case the ultrasonic transducer may be used to perform the ablation by radiating ablating ultrasound, and there is no need for a separate ablation element in the probe.
There is therefore provided, according to an embodiment of the present invention, a probe, including:
an ablation element which is configured to perform ablation of tissue; and
an ultrasonic transducer, located in proximity to the ablation element, which is configured to transmit acoustic radiation force impulses (ARFIs) to the tissue, and to measure a displacement of the tissue in response to the ARFIs so as to monitor the ablation thereof.
In an embodiment, the ablation element includes an aperture, and the ultrasonic transducer is configured to direct the ARFIs to the tissue via the aperture. The probe may include a good acoustic transmission medium which fills the aperture.
In a disclosed embodiment the ultrasonic transducer includes an array of transducer elements. The array may be configured to focus the ARFIs onto the tissue. Alternatively or additionally the array may be configured to generate an image of the tissue.
Typically, the ablation element includes an electrode configured to perform radio-frequency (RF) ablation of the tissue. In an embodiment, the electrode includes a sonolucent electrode, and the transducer is configured to transmit the ARFIs in response to receipt of electrical radio-frequency (RF) ARFI signals, to transmit ultrasonic tracking pulses via the sonolucent electrode to the tissue in response to receipt of electrical RF tracking pulses, to receive respective reflections of the ultrasonic tracking pulses from the tissue via the sonolucent electrode, and to generate electrical RF reflection pulses in response to the reflections. The probe may include a processor which is configured to convey the electrical RF ARFI pulses and the electrical RF tracking pulses to the transducer, and to receive the electrical RF reflection pulses from the transducer so as to measure the displacement of the tissue.
In a disclosed embodiment the ablation element includes a cooling element configured to perform cryogenic ablation of the tissue.
In an alternative disclosed embodiment the ablation element includes a microwave radiator configured to perform microwave ablation of the tissue.
There is further provided, according to an embodiment of the present invention, apparatus for ablating tissue, including:
a probe including an array of ultrasonic transducer elements which is configured to direct ultrasonic waves to the tissue in response to an electrical radio-frequency (RF) signal, and to receive reflected ultrasonic waves from the tissue; and
an RF transceiver, which:
in a first transceiver state is configured to convey an electrical ablating RF signal to the array causing the array to transmit ablation ultrasonic pulses to the tissue, the ablation ultrasonic pulses having an energy sufficient to cause ablation of the tissue,
in a second transceiver state is configured to convey an electrical acoustic radiation force impulse (ARFI) RF signal to the array causing the array to transmit an ARFI to the tissue, and
in a third transceiver state is configured:
to convey an electrical tracking RF signal to the array causing the array to transmit one or more tracking ultrasonic pulses to the tissue,
to receive electrical RF reflection signals from the array generated in response to the array receiving reflections of the one or more tracking ultrasonic pulses from the tissue, and to measure a displacement of the tissue in response to the electrical RF reflection signals, so as to monitor the ablation of the tissue.
Typically, the RF transceiver is configured in a fourth transceiver state to convey an electrical imaging RF signal to the array causing the array to transmit one or more imaging ultrasonic pulses to the tissue, and to receive electrical RF imaging reflection signals from the array generated in response to the array receiving reflections of the one or more imaging ultrasonic pulses from the tissue.
There is further provided, according to an embodiment of the present invention, a method for ablating tissue, including:
providing an ablation element;
performing ablation of the tissue using the ablation element;
locating an ultrasonic transducer in proximity to the ablation element;
transmitting acoustic radiation force impulses (ARFIs) from the transducer to the tissue; and
measuring a displacement of the tissue in response to the ARFIs so as to monitor the ablation thereof.
There is further provided, according to an embodiment of the present invention, a method for ablating tissue, including:
configuring a probe comprising an array of ultrasonic transducer elements to direct ultrasonic waves to the tissue in response to an electrical radio-frequency (RF) signal, and to receive reflected ultrasonic waves from the tissue; and
providing an RF transceiver, which:
in a first transceiver state is configured to convey an electrical ablating RF signal to the array causing the array to transmit ablation ultrasonic pulses to the tissue, the ablation ultrasonic pulses having an energy sufficient to cause ablation of the tissue,
in a second transceiver state is configured to convey an electrical acoustic radiation force impulse (ARFI) RF signal to the array causing the array to transmit an ARFI to the tissue, and
in a third transceiver state is configured:
to convey an electrical tracking RF signal to the array causing the array to transmit one or more tracking ultrasonic pulses to the tissue,
to receive electrical RF reflection signals from the array generated in response to the array receiving reflections of the one or more tracking ultrasonic pulses from the tissue, and to measure a displacement of the tissue in response to the electrical RF reflection signals, so as to monitor the ablation of the tissue.
The present invention will be more fully understood from the following detailed description of the embodiments thereof, taken together with the drawings in which: